In this episode, I’ll discuss whether etomidate can be given as a continuous infusion.
Etomidate is a non-barbituate, general anesthetic agent.
By far the most common use for etomidate in ICU patients is as an induction agent during rapid sequence intubation.
Etomidate would be effective at providing sedation as a continuous infusion however there is just one problem…it wouldn’t be safe.
Adrenal insufficiency occurs after continuous infusion of etomidate or repeated bolus doses. This does not occur to a clinically relevant level with single doses.
But there still might be a case where continuous infusion of etomidate is desirable: in the case of severe Cushing’s syndrome. We can use the adverse effect of continuous etomidate as a therapeutic benefit. In a case report of Ectopic Cushing’s syndrome from neuroendocrine carcinoma, etomidate was given as a 0.04 mg/kg/hour infusion for 2 weeks. The dose was gradually tapered down according to the daily cortisol results and a dose of 0.01 mg/kg/hour was used during the last 4 days of the infusion. The infusion was stopped the day before surgical resection. Interestingly, since this dose was much lower than what would be used for sedation, the patient did not experience any respiratory effects for the duration of the infusion.
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